| NPI | 1578653580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60045752) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 51577723902) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-10-23 |